Hospital Medicine Alert
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High-flow Nasal Cannula vs. Noninvasive Ventilation in Postextubation Failure
SYNOPSIS: In this multicenter, randomized, clinical trial of critically ill adults at high risk for reintubation, high-flow conditioned oxygen therapy was not inferior to noninvasive mechanical ventilation with regard to preventing reintubation and postextubation respiratory failure within 72 hours of extubation.
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Diastolic Blood Pressure Goals
SYNOPSIS: An analysis of the community-based ARIC study showed that low diastolic blood pressures were associated with higher baseline and subsequent troponin T levels and adverse cardiac events, but not stroke.
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Pulmonary Embolism Common Cause for Syncope in Hospitalized Patients
Syncope is a chief complaint for which neurologists often are consulted. In most cases, the neurological concern is possible stroke or an epileptic seizure. However, a variety of cardiopulmonary problems are most often the underlying cause of syncope, including cardiac arrhythmias and pulmonary embolism. The investigators of this study reviewed the clinical records of 560 patients (mean age of 76 years) who were admitted to the hospital with syncope.
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New Paradigm in the Management of Massive and Submassive Pulmonary Embolism
SYNOPSIS: A multidisciplinary pulmonary embolism response team is a sustainable option to improve care for severe pulmonary embolism.
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VRE and MRSA: Should We Stop Routine Contact Precautions?
SYNOPSIS: The value of routine contact precautions for VRE and MRSA is strongly challenged.
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Warning: Reactivation of Hepatitis B Virus Coinfection During Treatment of Chronic Hepatitis C Virus Infection
SYNOPSIS: Prior to initiation of hepatitis C virus treatment with direct-acting antivirals, patients should be screened for hepatitis B virus coinfection. Those who are hepatitis B virus-infected should receive ongoing monitoring for flares and reactivation of hepatitis B.
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Vasopressin as a Single Vasopressor Agent in Patients with Septic Shock
SYNOPSIS: The use of vasopressin as a vasopressor for septic shock produced similar outcomes as the use of norepinephrine.
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What Influences ICU Admission?
SYNOPSIS: There is widespread variability between hospitals in rates of ICU admission. High ICU utilization hospitals were more likely to use invasive procedures and incurred higher costs than low ICU utilization hospitals with no difference in mortality.
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Reported Beta-lactam Allergy Is Associated with More Adverse Events Among Inpatients
SYNOPSIS: A prospective cohort study from three hospitals determined that patients who did not receive a preferred beta-lactam antibiotic were at greater risk for an adverse event (adjusted odds ratio, 3.1; 95% confidence interval, 1.28-7.89) compared to controls without a beta-lactam allergy.
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Outcomes in Patients Treated with Therapeutic Hypothermia After In-hospital Cardiac Arrest
SYNOPSIS: Current guidelines recommend the use of therapeutic hypothermia in patients with in-hospital cardiac arrest, even though its efficacy has been demonstrated only in randomized trials after out-of-hospital cardiac arrest. This non-randomized, observational cohort study based on a large national registry found that the use of therapeutic hypothermia was associated with lower likelihood of survival and less favorable neurological outcome in patients successfully resuscitated after an in-hospital cardiac arrest.